Introduction

Bipolar disorder, also known as manic-depressive illness, is a brain
disorder that causes unusual shifts in a person's mood, energy, and ability
to function. Different from the normal ups and downs that everyone goes
through, the symptoms of bipolar disorder are severe. They can result in
damaged relationships, poor job or school performance, and even suicide.
But there is good news: bipolar disorder can be treated, and people with
this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population
age 18 and older in any given year,1 have
bipolar disorder. Bipolar disorder typically develops in late adolescence
or early adulthood. However, some people have their first symptoms during
childhood, and some develop them late in life. It is often not recognized
as an illness, and people may suffer for years before it is properly
diagnosed and treated. Like diabetes or heart disease, bipolar disorder is
a long-term illness that must be carefully managed throughout a person's
life.

"Manic-depression distorts moods and thoughts, incites dreadful
behaviors, destroys the basis of rational thought, and too often erodes
the desire and will to live. It is an illness that is biological in its
origins, yet one that feels psychological in the experience of it; an
illness that is unique in conferring advantage and pleasure, yet one that
brings in its wake almost unendurable suffering and, not infrequently,
suicide."

"I am fortunate that I have not died from my illness, fortunate in
having received the best medical care available, and fortunate in having
the friends, colleagues, and family that I do."

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings—from overly "high" and/or
irritable to sad and hopeless, and then back again, often with periods of
normal mood in between. Severe changes in energy and behavior go along with
these changes in mood. The periods of highs and lows are called
episodes of mania and depression.

Signs and symptoms of mania (or a manic episode)
include:

Increased energy, activity, and restlessness

Excessively "high," overly good, euphoric mood

Extreme irritability

Racing thoughts and talking very fast, jumping from one idea to
another

A manic episode is diagnosed if elevated mood occurs with three or more of
the other symptoms most of the day, nearly every day, for 1 week or longer.
If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive
episode) include:

Lasting sad, anxious, or empty mood

Feelings of hopelessness or pessimism

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in activities once enjoyed, including
sex

Decreased energy, a feeling of fatigue or of being "slowed down"

Difficulty concentrating, remembering, making decisions

Restlessness or irritability

Sleeping too much, or can't sleep

Change in appetite and/or unintended weight loss or gain

Chronic pain or other persistent bodily symptoms that are not caused by
physical illness or injury

Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last
most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania.
Hypomania may feel good to the person who experiences it and may even be
associated with good functioning and enhanced productivity. Thus even when
family and friends learn to recognize the mood swings as possible bipolar
disorder, the person may deny that anything is wrong. Without proper
treatment, however, hypomania can become severe mania in some people or can
switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of
psychosis (or psychotic symptoms). Common psychotic
symptoms are hallucinations (hearing, seeing, or otherwise sensing the
presence of things not actually there) and delusions (false, strongly held
beliefs not influenced by logical reasoning or explained by a person's
usual cultural concepts). Psychotic symptoms in bipolar disorder tend to
reflect the extreme mood state at the time. For example, delusions of
grandiosity, such as believing one is the President or has special powers
or wealth, may occur during mania; delusions of guilt or worthlessness,
such as believing that one is ruined and penniless or has committed some
terrible crime, may appear during depression. People with bipolar disorder
who have these symptoms are sometimes incorrectly diagnosed as having
schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder
as a spectrum or continuous range. At one end is severe depression, above
which is moderate depression and then mild low mood, which many people call
"the blues" when it is short-lived but is termed "dysthymia" when it is
chronic. Then there is normal or balanced mood, above which comes hypomania
(mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur
together in what is called a mixed bipolar state. Symptoms
of a mixed state often include agitation, trouble sleeping, significant
change in appetite, psychosis, and suicidal thinking. A person may have a
very sad, hopeless mood while at the same time feeling extremely
energized.

Bipolar disorder may appear to be a problem other than mental illness—for
instance, alcohol or drug abuse, poor school or work performance, or
strained interpersonal relationships. Such problems in fact may be signs of
an underlying mood disorder.

Diagnosis of Bipolar Disorder

Like other mental illnesses, bipolar disorder cannot yet be identified
physiologically—for example, through a blood test or a brain scan.
Therefore, a diagnosis of bipolar disorder is made on the basis of
symptoms, course of illness, and, when available, family history. The
diagnostic criteria for bipolar disorder are described in the
Diagnostic and Statistical Manual for Mental Disorders, fourth edition
(DSM-IV).2

Descriptions offered by people with bipolar disorder give valuable
insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do
anything well. It seems as though my mind has slowed down and burned
out to the point of being virtually useless…. [I am] haunt[ed]… with
the total, the desperate hopelessness of it all…. Others say, "It's
only temporary, it will pass, you will get over it," but of course they
haven't any idea of how I feel, although they are certain they do. If I
can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous…
ideas are fast… like shooting stars you follow until brighter ones
appear…. All shyness disappears, the right words and gestures are
suddenly there… uninteresting people, things become intensely
interesting. Sensuality is pervasive, the desire to seduce and be
seduced is irresistible. Your marrow is infused with unbelievable
feelings of ease, power, well-being, omnipotence, euphoria… you can do
anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are
far too many… overwhelming confusion replaces clarity… you stop keeping
up with it—memory goes. Infectious humor ceases to amuse. Your friends
become frightened…. everything is now against the grain… you are
irritable, angry, frightened, uncontrollable, and trapped.

Suicide

Some people with bipolar disorder become suicidal. Anyone who is
thinking about committing suicide needs immediate attention, preferably
from a mental health professional or a physician. Anyone who talks about
suicide should be taken seriously. Risk for suicide appears to
be higher earlier in the course of the illness. Therefore, recognizing
bipolar disorder early and learning how best to manage it may decrease the
risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include:

talking about feeling suicidal or wanting to die

feeling hopeless, that nothing will ever change or get better

feeling helpless, that nothing one does makes any difference

feeling like a burden to family and friends

abusing alcohol or drugs

putting affairs in order (e.g., organizing finances or giving away
possessions to prepare for one's death)

writing a suicide note

putting oneself in harm's way, or in situations where there is a danger
of being killed

If you are feeling suicidal or know someone who is:

call a doctor, emergency room, or 911 right away to get immediate
help

make sure you, or the suicidal person, are not left alone

make sure that access is prevented to large amounts of medication,
weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are
impulsive acts that have not been well thought out; thus, the final point
in the box above may be a valuable long-term strategy for people
with bipolar disorder. Either way, it is important to understand that
suicidal feelings and actions are symptoms of an illness that can be
treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder?

Episodes of mania and depression typically recur across the life span.
Between episodes, most people with bipolar disorder are free of symptoms,
but as many as one-third of people have some residual symptoms. A small
percentage of people experience chronic unremitting symptoms despite
treatment.3

The classic form of the illness, which involves recurrent episodes of
mania and depression, is called bipolar I disorder. Some
people, however, never develop severe mania but instead experience milder
episodes of hypomania that alternate with depression; this form of the
illness is called bipolar II disorder. When four or more
episodes of illness occur within a 12-month period, a person is said to
have rapid-cycling bipolar disorder. Some people
experience multiple episodes within a single week, or even within a single
day. Rapid cycling tends to develop later in the course of illness and is
more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when
the illness is effectively treated (see below—"How Is
Bipolar Disorder Treated?"). Without treatment, however, the natural
course of bipolar disorder tends to worsen. Over time a person may suffer
more frequent (more rapid-cycling) and more severe manic and depressive
episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help
reduce the frequency and severity of episodes and can help people with
bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder?

Both children and adolescents can develop bipolar disorder. It is more
likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more
clearly defined, children and young adolescents with the illness often
experience very fast mood swings between depression and mania many times
within a day.5 Children with mania are more
likely to be irritable and prone to destructive tantrums than to be overly
happy and elated. Mixed symptoms also are common in youths with bipolar
disorder. Older adolescents who develop the illness may have more classic,
adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart
from other problems that may occur in these age groups. For example, while
irritability and aggressiveness can indicate bipolar disorder, they also
can be symptoms of attention deficit hyperactivity disorder, conduct
disorder, oppositional defiant disorder, or other types of mental disorders
more common among adults such as major depression or schizophrenia. Drug
abuse also may lead to such symptoms.

For any illness, however, effective treatment depends on appropriate
diagnosis. Children or adolescents with emotional and behavioral symptoms
should be carefully evaluated by a mental health professional. Any
child or adolescent who has suicidal feelings, talks about suicide, or
attempts suicide should be taken seriously and should receive immediate
help from a mental health specialist.

What Causes Bipolar Disorder?

Scientists are learning about the possible causes of bipolar disorder
through several kinds of studies. Most scientists now agree that there is
no single cause for bipolar disorder—rather, many factors act together to
produce the illness.

Because bipolar disorder tends to run in families, researchers have been
searching for specific genes—the microscopic "building blocks" of DNA
inside all cells that influence how the body and mind work and grow—passed
down through generations that may increase a person's chance of developing
the illness. But genes are not the whole story. Studies of identical twins,
who share all the same genes, indicate that both genes and other factors
play a role in bipolar disorder. If bipolar disorder were caused entirely
by genes, then the identical twin of someone with the illness would
always develop the illness, and research has shown that this is
not the case. But if one twin has bipolar disorder, the other twin is more
likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder,
like other mental illnesses, does not occur because of a single
gene.7 It appears likely that many different
genes act together, and in combination with other factors of the person or
the person's environment, to cause bipolar disorder. Finding these genes,
each of which contributes only a small amount toward the vulnerability to
bipolar disorder, has been extremely difficult. But scientists expect that
the advanced research tools now being used will lead to these discoveries
and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the
brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging
techniques allow researchers to take pictures of the living brain at work,
to examine its structure and activity, without the need for surgery or
other invasive procedures. These techniques include magnetic resonance
imaging (MRI), positron emission tomography (PET), and functional magnetic
resonance imaging (fMRI). There is evidence from imaging studies that the
brains of people with bipolar disorder may differ from the brains of
healthy individuals. As the differences are more clearly identified and
defined through research, scientists will gain a better understanding of
the underlying causes of the illness, and eventually may be able to predict
which types of treatment will work most effectively.

How Is Bipolar Disorder Treated?

Most people with bipolar disorder—even those with the most severe
forms—can achieve substantial stabilization of their mood swings and
related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness,
long-term preventive treatment is strongly recommended and almost always
indicated. A strategy that combines medication and psychosocial treatment
is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is
continuous than if it is on and off. But even when there are no breaks in
treatment, mood changes can occur and should be reported immediately to
your doctor. The doctor may be able to prevent a full-blown episode by
making adjustments to the treatment plan. Working closely with the doctor
and communicating openly about treatment concerns and options can make a
difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep
patterns, and life events may help people with bipolar disorder and their
families to better understand the illness. This chart also can help the
doctor track and treat the illness most effectively.

Medications

Medications for bipolar disorder are prescribed by psychiatrists—medical
doctors (M.D.) with expertise in the diagnosis and treatment of mental
disorders. While primary care physicians who do not specialize in
psychiatry also may prescribe these medications, it is recommended that
people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help
control bipolar disorder.10 Several
different types of mood stabilizers are available. In general, people with
bipolar disorder continue treatment with mood stabilizers for extended
periods of time (years). Other medications are added when necessary,
typically for shorter periods, to treat episodes of mania or depression
that break through despite the mood stabilizer.

Lithium, the first mood-stabilizing medication approved by the U.S.
Food and Drug Administration (FDA) for treatment of mania, is often very
effective in controlling mania and preventing the recurrence of both
manic and depressive episodes.

Anticonvulsant medications, such as valproate (Depakote®) or
carbamazepine (Tegretol®), also can have mood-stabilizing
effects and may be especially useful for difficult-to-treat bipolar
episodes. Valproate was FDA-approved in 1995 for treatment of mania.

Newer anticonvulsant medications, including lamotrigine
(Lamictal®), gabapentin (Neurontin®), and
topiramate (Topamax®), are being studied to determine how well
they work in stabilizing mood cycles.

Anticonvulsant medications may be combined with lithium, or with each
other, for maximum effect.

Children and adolescents with bipolar disorder generally are treated
with lithium, but valproate and carbamazepine also are used. Researchers
are evaluating the safety and efficacy of these and other psychotropic
medications in children and adolescents. There is some evidence that
valproate may lead to adverse hormone changes in teenage girls and
polycystic ovary syndrome in women who began taking the medication
before age 20.13Therefore,
young female patients taking valproate should be monitored carefully by
a physician.

Women with bipolar disorder who wish to conceive, or who become
pregnant, face special challenges due to the possible harmful effects of
existing mood stabilizing medications on the developing fetus and the
nursing infant.14 Therefore, the benefits
and risks of all available treatment options should be discussed with a
clinician skilled in this area. New treatments with reduced risks during
pregnancy and lactation are under study.

Treatment of Bipolar Depression

Research has shown that people with bipolar disorder are at risk of
switching into mania or hypomania, or of developing rapid cycling, during
treatment with antidepressant medication.15
Therefore, "mood-stabilizing" medications generally are required, alone
or in combination with antidepressants, to protect people with bipolar
disorder from this switch. Lithium and valproate are the most
commonly used mood-stabilizing drugs today. However, research studies
continue to evaluate the potential mood-stabilizing effects of newer
medications.

Atypical antipsychotic medications, including clozapine
(Clozaril®), olanzapine (Zyprexa®), risperidone
(Risperdal®), quetiapine (Seroquel®), and
ziprasidone (Geodon®), are being studied as possible
treatments for bipolar disorder. Evidence suggests clozapine may be
helpful as a mood stabilizer for people who do not respond to lithium or
anticonvulsants.16 Other research has
supported the efficacy of olanzapine for acute mania, an indication that
has recently received FDA approval.17
Olanzapine may also help relieve psychotic depression.18

If insomnia is a problem, a high-potency benzodiazepine medication such
as clonazepam (Klonopin®) or lorazepam (Ativan®)
may be helpful to promote better sleep. However, since these medications
may be habit-forming, they are best prescribed on a short-term basis.
Other types of sedative medications, such as zolpidem
(Ambien®), are sometimes used instead.

Changes to the treatment plan may be needed at various times during the
course of bipolar disorder to manage the illness most effectively. A
psychiatrist should guide any changes in type or dose of medication.

Be sure to tell the psychiatrist about all other prescription drugs,
over-the-counter medications, or natural supplements you may be taking.
This is important because certain medications and supplements taken
together may cause adverse reactions.

To reduce the chance of relapse or of developing a new episode, it is
important to stick to the treatment plan. Talk to your doctor if you have
any concerns about the medications.

Thyroid Function

People with bipolar disorder often have abnormal thyroid gland
function.4 Because too much or too little
thyroid hormone alone can lead to mood and energy changes, it is important
that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and
may need to take thyroid pills in addition to their medications for bipolar
disorder. Also, lithium treatment may cause low thyroid levels in some
people, resulting in the need for thyroid supplementation.

Medication Side Effects

Before starting a new medication for bipolar disorder, always talk with
your psychiatrist and/or pharmacist about possible side effects. Depending
on the medication, side effects may include weight gain, nausea, tremor,
reduced sexual drive or performance, anxiety, hair loss, movement problems,
or dry mouth. Be sure to tell the doctor about all side effects you notice
during treatment. He or she may be able to change the dose or offer a
different medication to relieve them. Your medication should not be changed
or stopped without the psychiatrist's guidance.

Psychosocial Treatments

As an addition to medication, psychosocial treatments—including certain
forms of psychotherapy (or "talk" therapy)—are helpful in providing
support, education, and guidance to people with bipolar disorder and their
families. Studies have shown that psychosocial interventions can lead to
increased mood stability, fewer hospitalizations, and improved functioning
in several areas.12 A licensed
psychologist, social worker, or counselor typically provides these
therapies and often works together with the psychiatrist to monitor a
patient's progress. The number, frequency, and type of sessions should be
based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are
cognitive behavioral therapy, psychoeducation, family therapy, and a newer
technique, interpersonal and social rhythm therapy. NIMH researchers are
studying how these interventions compare to one another when added to
medication treatment for bipolar disorder.

Cognitive behavioral therapy helps people with bipolar disorder learn
to change inappropriate or negative thought patterns and behaviors
associated with the illness.

Psychoeducation involves teaching people with bipolar disorder about
the illness and its treatment, and how to recognize signs of relapse so
that early intervention can be sought before a full-blown illness episode
occurs. Psychoeducation also may be helpful for family members.

Family therapy uses strategies to reduce the level of distress within
the family that may either contribute to or result from the ill person's
symptoms.

Interpersonal and social rhythm therapy helps people with bipolar
disorder both to improve interpersonal relationships and to regularize
their daily routines. Regular daily routines and sleep schedules may help
protect against manic episodes.

As with medication, it is important to follow the treatment plan for
any psychosocial intervention to achieve the greatest benefit.

Other Treatments

In situations where medication, psychosocial treatment, and the
combination of these interventions prove ineffective, or work too slowly
to relieve severe symptoms such as psychosis or suicidality,
electroconvulsive therapy (ECT) may be considered. ECT may also be
considered to treat acute episodes when medical conditions, including
pregnancy, make the use of medications too risky. ECT is a highly
effective treatment for severe depressive, manic, and/or mixed episodes.
The possibility of long-lasting memory problems, although a concern in
the past, has been significantly reduced with modern ECT techniques.
However, the potential benefits and risks of ECT, and of available
alternative interventions, should be carefully reviewed and discussed
with individuals considering this treatment and, where appropriate, with
family or friends.19

Herbal or natural supplements, such as St. John's wort (Hypericum
perforatum), have not been well studied, and little is known about
their effects on bipolar disorder. Because the FDA does not regulate
their production, different brands of these supplements can contain
different amounts of active ingredient. Before trying herbal or
natural supplements, it is important to discuss them with your doctor.
There is evidence that St. John's wort can reduce the effectiveness of
certain medications.20 In addition,
like prescription antidepressants, St. John's wort may cause a switch
into mania in some individuals with bipolar disorder, especially if no
mood stabilizer is being taken.21

Omega-3 fatty acids found in fish oil are being studied to determine
their usefulness, alone and when added to conventional medications, for
long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated

Even though episodes of mania and depression naturally come and go, it is
important to understand that bipolar disorder is a long-term illness that
currently has no cure. Staying on treatment, even during well times, can
help keep the disease under control and reduce the chance of having
recurrent, worsening episodes.

Do Other Illnesses Co-occur with Bipolar Disorder?

Alcohol and drug abuse are very common among people with bipolar disorder.
Research findings suggest that many factors may contribute to these
substance abuse problems, including self-medication of symptoms, mood
symptoms either brought on or perpetuated by substance abuse, and risk
factors that may influence the occurrence of both bipolar disorder and
substance use disorders.23 Treatment for
co-occurring substance abuse, when present, is an important part of the
overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and
obsessive-compulsive disorder, also may be common in people with bipolar
disorder.24,25
Co-occurring anxiety disorders may respond to the treatments used for
bipolar disorder, or they may require separate treatment. For more
information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar
Disorder?

Anyone with bipolar disorder should be under the care of a psychiatrist
skilled in the diagnosis and treatment of this disease. Other mental health
professionals, such as psychologists, psychiatric social workers, and
psychiatric nurses, can assist in providing the person and family with
additional approaches to treatment.

Help can be found at:

University—or medical school—affiliated programs

Hospital departments of psychiatry

Private psychiatric offices and clinics

Health maintenance organizations (HMOs)

Offices of family physicians, internists, and pediatricians

Public community mental health centers

People with bipolar disorder may need help to get help.

Often people with bipolar disorder do not realize how impaired they
are, or they blame their problems on some cause other than mental
illness.

A person with bipolar disorder may need strong encouragement from
family and friends to seek treatment. Family physicians can play an
important role in providing referral to a mental health
professional.

Sometimes a family member or friend may need to take the person with
bipolar disorder for proper mental health evaluation and treatment.

A person who is in the midst of a severe episode may need to be
hospitalized for his or her own protection and for much-needed treatment.
There may be times when the person must be hospitalized against his or
her wishes.

Ongoing encouragement and support are needed after a person obtains
treatment, because it may take a while to find the best treatment plan
for each individual.

In some cases, individuals with bipolar disorder may agree, when the
disorder is under good control, to a preferred course of action in the
event of a future manic or depressive relapse.

Like other serious illnesses, bipolar disorder is also hard on spouses,
family members, friends, and employers.

Family members of someone with bipolar disorder often have to cope with
the person's serious behavioral problems, such as wild spending sprees
during mania or extreme withdrawal from others during depression, and the
lasting consequences of these behaviors.

Many people with bipolar disorder benefit from joining support groups
such as those sponsored by the National Depressive and Manic Depressive
Association (NDMDA), the National Alliance for the Mentally Ill (NAMI),
and the National Mental Health Association (NMHA). Families and friends
can also benefit from support groups offered by these organizations. For
contact information, see the "For More Information"
section at the back of this booklet.

What About Clinical Studies for Bipolar Disorder?

Some people with bipolar disorder receive medication and/or psychosocial
therapy by volunteering to participate in clinical studies (clinical
trials). Clinical studies involve the scientific investigation of illness
and treatment of illness in humans. Clinical studies in mental health can
yield information about the efficacy of a medication or a combination of
treatments, the usefulness of a behavioral intervention or type of
psychotherapy, the reliability of a diagnostic procedure, or the success of
a prevention method. Clinical studies also guide scientists in learning how
illness develops, progresses, lessens, and affects both mind and body.
Millions of Americans diagnosed with mental illness lead healthy,
productive lives because of information discovered through clinical
studies. These studies are not always right for everyone, however. It is
important for each individual to consider carefully the possible risks and
benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of "real-world"
clinical studies. They are called "real-world" studies for several reasons.
Unlike traditional clinical trials, they offer multiple different
treatments and treatment combinations. In addition, they aim to include
large numbers of people with mental disorders living in communities
throughout the U.S. and receiving treatment across a wide variety of
settings. Individuals with more than one mental disorder, as well as those
with co-occurring physical illnesses, are encouraged to consider
participating in these new studies. The main goal of the real-world studies
is to improve treatment strategies and outcomes for all people with these
disorders. In addition to measuring improvement in illness symptoms, the
studies will evaluate how treatments influence other important, real-world
issues such as quality of life, ability to work, and social functioning.
They also will assess the cost-effectiveness of different treatments and
factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder
(STEP-BD) is seeking participants for the largest-ever, "real-world" study
of treatments for bipolar disorder. To learn more about STEP-BD or other
clinical studies, see the Clinical Trials page on the NIMH Web site http://www.nimh.nih.gov, visit the National Library of Medicine's
clinical trials database http://www.clinicaltrials.gov,
or contact NIMH.

For More Information

Addendum to Bipolar January 2007

Aripiprazole (Abilify) is another atypical antipsychotic medication used
to treat the symptoms of schizophrenia and manic or mixed (manic and
depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and
liquid form. An injectable form is used in the treatment of symptoms of
agitation in schizophrenia and manic or mixed episodes of bipolar I
disorder.

This publication, written by Melissa Spearing of NIMH, is a revision and
update of an earlier version by Mary Lynn Hendrix. Scientific information
and review were provided by NIMH Director Steven E. Hyman, M.D., and NIMH
staff members Matthew V. Rudorfer, M.D., and Jane L. Pearson, Ph.D.
Editorial assistance was provided by Clarissa K. Wittenberg, Margaret
Strock, and Lisa D. Alberts of NIMH.

NIH Publication No. 3679
Printed 2002

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